A Baltimore anesthesiologist who made national news as "The New Doctor Death" held the hands of six elderly Marylanders as they asphyxiated themselves with helium and then covered up their suicides, officials said in a state order they filed this month to strip him of his medical license.
The suicides are among nearly 300 nationwide that Dr. Lawrence D. Egbert said he helped to arrange as an "exit guide" for the right-to-die group Final Exit Network.
Egbert and several colleagues were arrested in 2009 amid an undercover investigation in Georgia, but he has avoided any punishment there or in another case in Arizona. He awaits trial for allegedly assisting in a suicide in Minnesota.
The Maryland Board of Physicians, which conducted a two-year review of his actions in the state, said they were unethical and illegal and revoked his license.
Egbert, 87, said he plans to appeal. Board officials would not say whether they referred Egbert's case to law enforcement, and no law enforcement official reached by The Baltimore Sun would confirm an investigation.
The board's decision brings the national debate over assisted suicide to Maryland. Three states have passed laws legalizing it, and some here, including former gubernatorial candidate Del. Heather Mizeur, would have Maryland join them. Lawmakers say the issue has never been the topic of serious discussion in Annapolis, but suspect it could become so.
The debate received national attention before and after a 29-year-old woman with brain cancer committed suicide Nov. 1. Brittany Maynard had moved to Oregon to take advantage of that state's "death with dignity" law.
Opponents of such measures celebrated Egbert's punishment.
"Revocation of his medical license is a good thing and long overdue," said Stephen Drake, a research analyst with Not Dead Yet, a Rochester, N.Y., group that advocates for people with disabilities and the elderly.
But those who support the legalization of assisted suicide said they would continue undaunted by the Maryland board's action against Egbert.
"He has long been a pioneer for so many things," said Frank Kavanaugh, a board member of the Final Exit Network, which is based in Tallahassee, Fla. "He's an important part of our history. He's been before various legal proceedings before and survived them all."
Egbert, who no longer works with the network, said he stands by his actions.
"This is something that's legitimate," the Hampden man said. "It's in the Bible as legitimate."
The Maryland board, tipped by a Baltimore Sun article in which he said he had assisted in a handful of suicides in Maryland as medical director of the Final Exit Network, charged Egbert in 2012 with unprofessional conduct.
By then, Newsweek had already dubbed Egbert the "New Doctor Death" — the heir to Jack Kevorkian, the Michigan pathologist who said he assisted in more than 130 suicides before he was convicted of second-degree murder in one death and sentenced to 10 to 25 years in prison.
In its order to revoke Egbert's license, the Maryland Board of Physicians said the Final Exit Network gives patients a book detailing how to commit suicide by placing a hood or bag over the head and filling it with helium.
Egbert said the group does not send patients the book but recommends that they read it.
If patients want to go forward with suicide, the board said, they are given an "exit guide" who rehearses the suicide and then holds the person's hand — both for comfort and to prevent the person "from involuntarily displacing the bag during suicide," the board said.
After the person's death, the board said, the exit guide removes the "suicide paraphernalia … to prevent the cause of death from being determined … and to hinder police investigations into the circumstances of the death."
Egbert acknowledged removing items after some of the deaths he assisted. He said the point is not to hide evidence but to protect the privacy of the patient and the patient's family.
He said in some cases, family members are the ones to remove the hood and helium tanks. In other cases, he said, they are not removed.
The board cited Egbert in six suicides in Maryland from 2004 to 2008. He told The Baltimore Sun Tuesday that he has assisted in 15 in Maryland.
In each case, the board said, the patients were not terminally ill — that is, they were not expected to die within six months. Their ages ranged from 68 to 87, the board said, and they suffered from illnesses including Parkinson's disease, multiple sclerosis, chronic obstructive pulmonary disease, and in one case, depression.
In one case, the board said, Egbert helped an 85-year-old woman with a history of diabetes, coronary artery disease and depression kill herself to leave money for a trust for a son who had Asperger syndrome. Her death certificate said she died of heart failure, the board said.
In another case, the board said, Egbert assisted in the suicide of an 87-year-old woman with worsening depression, but her death certificate said she died of cardiovascular disease.
The board found that the actions violated the ethics of the American Medical Association and Maryland law, which prohibits providing a physical means to commit suicide or participating in another's suicide.
It's not clear if Egbert is or has ever been the subject of a criminal investigation in Maryland. He said he was not aware of any investigation.
Spokesmen for Baltimore and Baltimore County police said they could not confirm any investigations. Officials with the Baltimore state's attorney's office and the state attorney general's office said they were not immediately able to provide information on any investigation. Baltimore County State's Attorney Scott Shellenberger said he was not aware of any investigation.
Egbert is awaiting trial in Minnesota in May for allegedly assisting in a suicide and interfering with a dead body there.
Authorities in Minnesota dropped charges related to a law against "advising and encouraging" suicide in June after a state court found the law unconstitutional.
An Arizona jury acquitted Egbert in the death of an Arizona woman in 2011. Charges against him in Georgia were dropped after the state's Supreme Court overturned a law limiting assisted suicide in 2012.
Several states have considered legalizing assisted suicide in recent years.
Washington state voters approved a death-with-dignity law in 2008, 14 years after Oregonians approved a similar measure. A 2009 court case in Montana essentially made assisted suicide legal there by allowing doctors to use consent as a defense. Vermont's state legislature approved an assisted-suicide law in 2013.
Massachusetts voters narrowly defeated an assisted-suicide referendum in 2012. The New Jersey General Assembly — the lower house of that state's legislature — approved assisted-suicide legislation last month. A similar bill is pending in the state Senate.
In Maryland, Mizeur made assisted suicide a campaign issue in her run for the Democratic nomination for governor. She lost in the Democratic primary to Lt. Gov. Anthony Brown, who lost the general election to Republican Larry Hogan, the governor-elect.
Del. Kathleen Dumais, vice chairwoman of the House Judiciary Committee, said she hasn't seen an assisted-suicide bill in her dozen years in the legislature, but she expects to have to grapple with the issue in the near future.
The Montgomery County Democrat said she has heard lawmakers discussing it, but does not see a groundswell of support for such a bill.
"We're going to see it in several legislatures across the country," Dumais said. "It's an ethical issue that people are thinking about deeply right now."
The assisted-suicide advocacy group Compassion & Choices is planning a push for legislation in Maryland and more than a dozen other states in 2015, spokeswoman Gwen Fitzgerald said.
The Denver-based group's efforts here started with a rally in Annapolis Nov. 19, on what would have been Maynard's 30th birthday.
Egbert said he doesn't plan to be active in that push, but he is "ready to talk to anybody who wants to" about assisted suicide.
He still gives talks on the issue, including a recent sermon at a Unitarian church in Virginia.
"I have a right to talk," Egbert said.
Baltimore Sun reporters Justin Fenton, Erin Cox and Michael Dresser contributed to this article.